Science Journal of Medicine and Clinical Trials
ISSN: 2276-7487
Published By
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© Author(s) 2015. CC Attribution 3.0 License.
Volume 2015, Article ID sjmct-260, 9 Pages, 2015. Doi:10.7237/sjmct/260
Research Article
Are We Empowered? A Qualitative Approach to Unfold The Experiences
of Female Nurses in Pakistan
Saleema Gulzar(MScN, BScN, BA, RN)
Aga Khan University, School of Nursing,
Karachi, Pakistan
Email: saleema.gulzar@aku.edu, Mobile: 0333-2356678
Dr. Rozina Karmaliani (PhD)
Aga Khan University, School of Nursing,
Karachi, Pakistan
rozina.karmaliani@aku.edu
Nasreen Lalani (PhD student)
University of Alberta, Canada
nasreen@ualberta.ca
Qurratulain Nasiruddin (MSc. Medical Anthropology- M.A. Muslim cultures; BScN)
Porgramme Co-ordinator, Urban Health Programme
Aga Khan University-Community Health Sciences
quratulain.nasirudin@aku.edu
Accepted on February 04, 2015
Abstract: The disparity of men and women in certain societies,
such as Pakistan, is a growing concern.
The disparity,
unchanging mind-set, and definitions rooted in traditions do not
free individuals from the socially bound gender identities. In
such circumstances, educational institutions can become a way of
transforming social structures. Considering female nurses in
Pakistan as a case study, this paper explores the notion of
‘empowerment’ and the factors responsible for empowerment or
disempowerment of female nurses. The study also evaluates the
role of a leading nursing institution in Pakistan namely the Aga
Khan University- School of Nursing and Midwifery (AKUSONAM) in empowering female nurses. The data is collected
through five focus group discussion among forty-five alumni of
AKU-SONAM. The findings of the study presents an ‘inside-out’
understanding of the term ‘empowerment’ by female nurses of
Pakistan and; enlists the challenges faced by women in Pakistan
in becoming and working as nurses. The study also put forward
recommendations for nursing professional bodies such as
Pakistan Nursing Council and Pakistan Nursing Federation and
other nursing institutions in Pakistan. The paper would serve as
a guide to enhance further development in nursing and women
empowerment.
Keywords: Women, Empowerment, Nurses, Pakistan
Introduction
Nurses pledge to offer care without any discrimination.
Unfortunately, their care is not always perceived in an
unbiased manner. Despite of nobility of their profession,
nurses face disempowerment at various levels due to
certain highly engraved and inevitable socio-cultural and
political factors. In the context of Pakistan, there are two
major challenges for nurses: a) Pakistan is a maledominated society whereas most of the nurses are
observed to be females; and b) Health care delivery
system of Pakistan tends to be hierarchical where
physicians and medical staff are seen superior to nurses.
Consequently, female nurses in Pakistan carry double
burden of subordination; as women and as nurses.
1.1 Women in Pakistan
The status of women in Pakistan is disheartening. The,
cultural, social and economic system of Pakistan is highly
dominated by strong patriarchal trends enrooted in deep
feudal and tribal value systems. Due to the patriarchal
nature of the society, there is apparent gender inequality
where the share of women in professional and related jobs
is relatively low and mostly confined to the traditional
teaching and medical professions (Pakistan Report, 2004).
Moreover, working women have to carry a dual
responsibility of work, contributing toward professional
as well as domestic chores. Because of this double liability,
Pakistani working women are struggling to balance out
their professional obligations. Along with this, the social,
historical, cultural, and economic dimensions are silently
undermining and damaging the status and rights of
women at every level and in all sectors, and hinder them
to participate in the decision-making process
autonomously,
1.2 The Profession of Nursing in Pakistan
Inspite of being considered as a noble profession globally,
nursing not attract many females as a career in Pakistan
generally. Looking at the trend in Pakistan, mostly girls
from the lower strata of society join this profession which
highlights that the Pakistani society perceives nursing as a
mediocre or an inferior profession. Another challenge, as
asserted by Yusufzai (2006), is that the majority of
doctors, patients and their relatives regard nurses as sex
symbols. Due to this, among many other female
professions, nursing ranks much lower in status than
medicine. Hence, nurses are amongst the most oppressed
How to Cite this Article: Saleema Gulzar, Dr. Rozina Karmaliani , Nasreen Lalani , Qurratulain Nasiruddin , "Are We Empowered? A Qualitative Approach
to Unfold The Experiences of Female Nurses in Pakistan", Science Journal of Medicine and Clinical Trials, Volume 2015, Article ID sjmct-260, 9 Pages,
2015. Doi:10.7237/sjmct/260
Science Journal of Medicine and Clinical Trials (ISSN:2276-7487)
group of people and, consequently, not in a position to
raise their voice against injustices. Though the issues
pertaining to nurses status are centuries old (sheer 1996),
but it is unfortunate to see Pakistan still struggling hard in
giving due respect and social status to nurses.
Iliyas and Ansari (2000) highlighted the vicious cycle of
disempowerment amongst nurses. In their opinions, it is
the shortage of empowered nursing leaders in health
system of Pakistan due to which the image of nurses is not
improving. Subsequently, new generations do not perceive
the profession as honorable as it is. Yusufzai (2006) held
the nursing curriculum responsible for disempowerment
of nurses since the curriculum is outdated and does not
justify the contributions of nurses in health care delivery.
French, Watters, & Matthews (1994) indicates that nurses’
low living, poor training, and compromised working
conditions are answerable to lack of respect for nurses
and their occupation’s low social status. In view of all
these issues, Pakistani nurses are struggling against set
norms and many are making conscious efforts to improve
their professional status. At organizational level, the Aga
Khan University- School of Nursing and Midwifery (AKUSONAM) is one example.
P a g e |2
Science of Nursing (MSc.N). In addition, there are various
other post-graduate nursing and trainings programs on
diverse themes which enable students, faculty member
and staff to specialize their fields of interest.
Though, the school gives equal opportunities to men and
women to pursuit career in nursing; a founding objective
of the school was to empower female nurses in Pakistan.
Subsequently, one may observe that female students and
nursing staff dominate the profession. This particular
study aim to evaluate the role of AKU-SONAM in
empowering nurses in Pakistan from an Inside out
approach. By the term ‘inside out’, the study intends to
explore nurse’s own understanding of the term
‘empowerment’ both in their personal and professional
lives.
This study was conducted in 2010 as a sub-component of a
larger research consortium named as Women
Empowerment in Muslim Context: Gender, Poverty and
Democratization from Inside out (WEMC). This research
project was funded by the Department For International
Development (DFID) and led by City University’s and South
East Asia Research Center (SEARC) department for
International Development, Hong Kong along with eight
partners where two were from Pakistan.
1.3 AKU-SONAM: A Trend Setter
Established in 1980, the Aga Khan University School of
Nursing and Midwifery (AKU-SONAM) pioneered a
challenge to this dual burden. AKU-SONAM has succeeded
in influencing the Pakistan Nursing Federation (PNF) and
Pakistan Nursing Council (PNC) to legitimatize nursing as
a noble profession for women in Pakistan. The efforts are
akin to any social struggle and have created pathways for
a steady improvement of nurses as women, and women as
nurses. The Chancellor of the University, His Highness the
Prince Karim Aga Khan declared the vision of AKUSON as:
“To develop a guiding light, a light to added to
those many others which seek to illuminate the
path to a better life for Pakistan, for the people of
the Ummah and of the Third World” (His Highness
The Aga Khan, 1983 as cited in Student Handbook,
2010).
With such a broad vision, the university endeavors to
encourage a positive attitude towards this much neglected
profession (Hemani 1996). Besides strengthening the
educational system particularly nursing education in the
country, the university acts as a role model for other
educational institutions. The university is expanding in
other countries including Afghanistan, Syria and countries
in East Africa. With continual efforts, the university has
now been transformed into a Centre of Excellence for
nursing education in the country with competent faculty
members in the field for various programs. The programs
include: Diploma in nursing (phased off in 2010);
Baccalaureate in the science of nursing (BSc.N); postdiploma baccalaureate in nursing (Post-RN BSc.N);
baccalaureate in Midwifery (BSc.M) and Masters in the
A qualitative study where AKUSONAM was taken as a case
study was design in order to explore the role of nursing
schools in empowering nurses as individual beings and as
professionals. The participants were female nursing
alumni of AKUSONAM working in either public or private
health institutions in Karachi irrespective of their
designation. In total, forty-five alumni (n=45) were
selected as participants through purposive sampling. The
participants were then divided into five different groups of
eight to ten participants each on the basis of their job
positions, titles, and experience. These five groups were:
1) Bed side Registered Nurses 2) Head Nurses, (HN), 3)
Nursing Managers, (NM), 4) Clinical Nurse Educators
(CNE) and; 5) Post RN-BScN students having prior clinical
nursing experience.
The opinions and experiences of the participants were
gathered through five focus group discussions (FGDs). The
discussion was carried out in the national language of
Pakistan that is Urdu along with English so that each
participant can and participate in the discussion. The
duration of each FGD varied from two to three hours
depending on the group participation. FGDs were audiorecorded, translated and transcribed later. Field notes
were also taken during discussion to note the nonverbal
responses of the participants and other significant
occurrences. All the data was collected with informed
verbal consent and a group consent form was signed
before each FGD. Using pseudonyms ensured participants’
anonymity. Data was kept confidential under lock and key
and was shared among the research team members only.
The discussion was initiated through semi-structured and
open ended questions; thus involving the participants in
the discussion at most.
How to Cite this Article: Saleema Gulzar, Dr. Rozina Karmaliani , Nasreen Lalani , Qurratulain Nasiruddin , "Are We Empowered? A Qualitative Approach
to Unfold The Experiences of Female Nurses in Pakistan", Science Journal of Medicine and Clinical Trials, Volume 2015, Article ID sjmct-260, 9 Pages,
2015. Doi:10.7237/sjmct/260
Science Journal of Medicine and Clinical Trials (ISSN:2276-7487)
The study was approved by the Ethical Review Committee
(ERC) of the AKU prior data collection. All the data was
collected after obtaining informed written consent from
the study participants. Confidentiality and anonymity of
the participants are fully assured at every stage of the
study. Participation in the study was voluntary and
participants had the right to withdraw at any stage of the
study.
3.0 Data Analysis:
The data was analyzed using NVIVO software (6.0)
package. Data collection and data analysis were done
simultaneously. Data analysis commenced with the first
interview and proceeded with data collection. The data
was initially translated into its original language Urdu and
then translated into English. While translation, some of the
words were kept in its original language to preserve the
originality of the content meaning and language
expression. Content analysis of the data was carried out.
Content analysis assists to interpret both manifest and the
latent data. Initially, the data was coded after reading each
statement in the data. Various codes and categories were
formulated by giving them meanings and shared among
the research team.
To improve the credibility of analysis, the whole team
reevaluated the formed codes and categories and reached
consensus. Using this approach, the data was condensed to
obtain the abstract meaning (manifest content) and what
the underlying meaning of the text (latent content). The
categories and sub categories were then put under several
themes and sub themes with the consensus of the research
team. Finally, a central core category and theme emerged
upon which all authors consented.
Findings
4.1 Understanding of the Term ‘Empowerment’:
The understanding of the participants on the term
‘empowerment’ was analyzed in following manners:
4.1.1 Meaning of Empowerment
Most of the participants explained empowerment as the
authority to take a decision and the freedom of exercising
one’s own power. A participant specified that decision
making involves integrating other’s views and ideas
irrespective of personal preferences. The decision could be
both, personal and professional. The point was argued by
another participant who believed that the authority to
make a decision comes on a condition that the decision
maker cannot always be able to contend every individual.
Therefore, the decision maker should not regret or feel
bad if other people are not supporting the decision.
“Every woman has a right to take decision for
herself. A woman should not stop availing her
rights just because other people are not happy. We
P a g e |3
all should understand that we cannot keep
everyone happy at all times” (Mrs. Shah, 2010)
In regards to power, a participant mentioned that power
should not be limited to personal or professional life only.
Power needs to be exhibited socially, morally and
politically. In her views, power acquisition requires
broadcasting of views through media in community. To
the participants at management level, power and authority
is followed by position at work place. A participant
shared,
“I used to teach nursing students in the same
manner as I do now; but since I am on a higher
rank (assistant professor), students and other
colleagues listen to my suggestions” (Ms. Seema,
2010)
Following, a participant contradicted that despite of her
authority and responsibility of maintaining norms and
discipline in ward, doctors do not follow her instructions.
The doctors over rule her decisions and act against her
will.
“Authority does not bring empowerment….I am a
head nurse and I have authority. My staff listens to
my instructions…but a doctor may come to my
office without permission and do whatever they
wish. I feel disempowered that way” (Mrs. Shabana,
2010).
To certain participants, empowerment is about advocating
for one’s own rights. It is the courage of putting forward
one’s own opinions and suggestions.
Participants
acknowledged that this initiative demands considerable
efforts since women face several social and cultural
restraints.
A participant mentioned that empowerment is about using
all potentials and capabilities within the available
resources and opportunities. To another participant,
empowerment and disempowerment are phases of one’s
life but courage to take risks and confront challenges is
required in each step.
“We are neither empowered nor disempowered. It is
about taking risks and confronting challenges
firmly” (Ms. Uzma, 2010).
To some participants, empowerment is solely about
receiving respect and importance from others while
another participant explained empowerment as one’s
belief and strength in own self.
4.1.2 Symbols of Empowerment
Participants associated empowerment with various
symbols such as: a) a hand over another showing unity; b)
a hand fist as symbol of authority; c) thumbs up meaning
victory; d) crown symbolizing power; e) a leader depicting
How to Cite this Article: Saleema Gulzar, Dr. Rozina Karmaliani , Nasreen Lalani , Qurratulain Nasiruddin , "Are We Empowered? A Qualitative Approach
to Unfold The Experiences of Female Nurses in Pakistan", Science Journal of Medicine and Clinical Trials, Volume 2015, Article ID sjmct-260, 9 Pages,
2015. Doi:10.7237/sjmct/260
Science Journal of Medicine and Clinical Trials (ISSN:2276-7487)
authority and power; f) a mother as an icon of care and
comfort; g) a woman with a book symbolizing the role of
education in attainment of power; h) a nurse with a book
on head and a candle in hand representing knowledge and
hope for an improved life and; i) a judicial court with
hammer. On the last symbol, some participants argued
that the symbol shows imposition of decisions, which does
not stand with the term empowerment.
authority and skills in particular communication skills. For
example, a nurse mentioned,
“I am the only daughter-in-law my family who is
educated and who works. My parents-in-law and
my husband, both feel proud. They also gives my
example to their daughters and other family
members…whenever they have to interact with
other people, they keep me on front…because my
communication is better than the way they do” (Ms.
Shahnama 2010).
4.2 Words for Empowerment
Later, the participants were requested to propose a word
synonymous to the term empowerment. They proposed
following words: dominancy; strength; power; positive
thinking; leadership and capacity building.
Sources of Empowerment
The sources of empowerment and dispowerment
identified by the participants can be illustrated through
figure 1.
4.3 Characteristics of Empowerment
On asking what constitutes empowerment, the
participants enlisted knowledge, confidence, power,
DISEMPOWERMENT
EMPOWERMENT
What
sources of
support
What
sources of
obstruction
OPPORTUNITIES
?
PERCEPTIONS OF SELF AND
VISION OF FUTURE
?
REINFORCE
CHANGE
EXISTING
GENDER
SYSTEM
EXISTING
RESOURCES
ECONOMIC STRUCTURE
P a g e |4
TRADITIONS, CUSTOMS
RELIGION
Figure 1. Diagram illustrating the vicious cycle of empowerment and dispowerment in a female nurse living in Pakistan.
As illustrated, the empowerment and/or disempowerment
of nurses are defined by several factors and, through
various dimensions. Mainly, a woman’s life in Pakistan is
determined by the existing gender system. Equally, her life
is dependent of resources available to her. Both, existing
notion of gender and resources are nurtured by economic
system, traditions and customs and religion of that society.
These three elementary sources of power are highly
influential that a person cannot skip their influence at
anywhere in the vicious cycle of power. The notion of
gender and resources are also responsible for constructing
women’s own perception of selfhood and her visions and
admirations in life. Led by those visions and admirations,
one explores opportunities to empower oneself. If
resources are highly constricted or the social system is
highly gender biased, then a woman may get
disempowered and keeps her vision always undermined.
Parallel to this cycle, there are always some sources of
obstructions and certain sources of support which work as
catalyst and enable a woman to feel lack of power or
empowered respectively.
4.3.2 Knowledge, Skill and Experience
Knowledge and skill were found to be most integral
sources of empowerment. Whether they are with the
family or in the profession, knowledge and competency
made them feel empowered. These sources enabled them
to stand firm and fight for their rights. The knowledge also
helped them identifying and making efficient utilization of
available resources.
“When you have knowledge, you can fight for your
rights confidently. Otherwise, you always remain
submissive to those who are more knowledgeable to
you” (Ms. Anita, 2010).
Very interestingly, a participant mentioned that, for
acquisition of power, knowledge must be accompanied by
the experience of working in field. Together, experience
and knowledge empower a person.
How to Cite this Article: Saleema Gulzar, Dr. Rozina Karmaliani , Nasreen Lalani , Qurratulain Nasiruddin , "Are We Empowered? A Qualitative Approach
to Unfold The Experiences of Female Nurses in Pakistan", Science Journal of Medicine and Clinical Trials, Volume 2015, Article ID sjmct-260, 9 Pages,
2015. Doi:10.7237/sjmct/260
Science Journal of Medicine and Clinical Trials (ISSN:2276-7487)
4.3.3 Self Confidence
The participants also believed that their self-confidence
led them to succeed. In their views, a person acquires
power and success by believing in one’s own self and
building on potentials mainly.
4.3.4 Struggle
From a gender perspective, participants mentioned that
struggle is must to empower own self. Constant struggles
and steadiness are integral to attain power. Participants
found struggle as elementary in empowering themselves
and their children as well. A participant shared:
“ I am empowering myself in order to support my
daughter… my life is full of struggle but I am aware
that if I won’t be firm now then my daughter will
face the same fate later so I have to struggle” (Ms.
Rehana, 2010).
4.3.5 Faith in God
To certain participants, faith in God enabled them to take
every step in life positively. Despite of hardships, their
faith helped them stay optimistic and progress in life
constantly. A participant described the role of faith in a
distinct manner. To her,
“There is certain kind of help or power which is ‘in
disguise’. I believe, that’s the divine help or the
courage blessed by the God. It happens when the
intentions of a person are pure and; trust me pure
intentions help a person to get through all highs
and tides of life” (Ms. Zulekha, 2010).
Another participant shared,
“Thanks God! I believe that it is my faith in the God
that He does always well to me. Therefore,
whatever I do, I know that it is guided by my God…
no matter, how difficult is it but I will get reward at
the end. This is the faith which enabled me to
further my education” (Ms. Mariam, 2010).
Thus, the participants suggest that a person must keep
strong faith in God and good intentions always. Then, the
God helps that person in disguise and all hurdles passed
away easily.
4.3.6 Marriage
Marriage appeared to be a controversial yet mostly
identified component. To some participants, marriage was
seen as a source of empowerment whereas other
participants considered it to be a source of
disempowerment. On one hand, the support of husband
and other members of family-in-law are mentioned to be
significant in fulfilling personal and professional duties. On
the other hand, the change of relationship and all the
P a g e |5
expectations brought by marriage in a woman’s life were
seen as few decelerating factors.
Again being a woman, participants mentioned to face
hurdles after marriage especially if the family-in-law is
patriarchal. Moreover, the socio-cultural of Pakistani
society where daughters-in-law are supposed to take care
of every member’s need and preferences, is identified to
be a big challenge for participants. Such family roles
demand considerable time and efforts and interferes one’s
individual preferences.
4.4 Empowerment in Personal Life:
The participants mentioned following impacts and
challenges in empowering themselves personally:
4.4.1 Challenges in Empowering Personal Life
The nature of female was considered to be the top most
challenge. On one hand, participants counted
subordinating and undemanding nature of female which
do not let them being assertive. On the other hand, their
experiences suggest that female do not support other
female. They envy one another and bring obstacles in
promotion and success of other females. Another
challenge was the social and cultural ideologies which
pose several impositions on women. An example is that
girls are forced to marry even before they finish their
studies. The other example is a prevailing thought that
women should not step out of house regardless of severe
financial constraints. Above all, the male dominated
culture of the Pakistan society where women do not feel
socially safe and secure in work environment and public
places. A participant working in a governmental hospital
mentioned:
“The male staff even clerical staff at hospital
harasses us. They disturb us emotionally and
psychologically to an extent that we cannot even
sleep at night. They look down upon nurses and
believe that nurses can do any illegal and
disrespectable favor to them…however, this is not
true” (Ms. Kulsoom, 2010).
Participants also highlighted family values as a significant
challenge. Certain participants enjoyed freedom at their
families and but they had a lot of restrictions by
parents-in-law. Contrarily, some participants were not
given liberty by their immediate parents but their spouse
or parents in law supported them.
This is also because of the conservative of mind-set of
Pakistani society where parents are concerned about their
daughter’s reputation and do not want to bring ill-name by
giving them liberty and freedom. Moreover, some families
value opinions and decisions of male over female family
members. In addition, some families are so authoritarian
that even if husband wishes to support his wife in studies
How to Cite this Article: Saleema Gulzar, Dr. Rozina Karmaliani , Nasreen Lalani , Qurratulain Nasiruddin , "Are We Empowered? A Qualitative Approach
to Unfold The Experiences of Female Nurses in Pakistan", Science Journal of Medicine and Clinical Trials, Volume 2015, Article ID sjmct-260, 9 Pages,
2015. Doi:10.7237/sjmct/260
Science Journal of Medicine and Clinical Trials (ISSN:2276-7487)
or job responsibilities; parents-in-law surpasses his
decisions.
4.4.2 Impacts of Empowerment in Personal Life
Participants experiences empowerment in maintaining
healthy relationships and build trust with other family
members. Indeed, their assertive and boldness helped
them re-built spoiled relationships between family
members. A participant mentioned that
“Empowerment has enabled me to put forward my
preferences and choices in front of the members of my
family-in-law” (Ms. Ghazala, 2010).
She exemplified by sharing an experience that:
“When mom was terminally-ill, doctors suggested
us to put her off the ventilator. My whole family was
against euthanasia except myself. My family
members thought that I am insensitive, brutal and
selfish but I stayed firmed on my decision. I had
learnt and observed patients in immense pain and
suffering during ventilator support and I didn’t
want my mother to bear all” (Mrs. Akbar, 2010).
Contrastingly, a participant mentioned that she has been
penalized and teased by her family members in the
attainment of education which supposedly empowers her.
Later, on the day of her graduation, her mother-in-law felt
proud when she saw her daughter-in-law receiving
nursing degree from such a reputable institution. This
occasion just not only brought happiness to family
members but also changed the perceptions and attitude of
her mother-in-law. Most of the participants found financial
contribution as a mean and an impact of empowerment in
family. The participants also consider themselves as role
models in their respective communities through which
other girls get inspiration to become a nurse.
4.4.3 Empowerment in Professional Life
Similarly, the opinions about
professional life were explored
subsequent responses:
empowerment in
which constitutes
4.5 Challenges in Empowering Professional Lives
The participants list down several challenges in acquiring
power and dignity as nurse in their professional life.
A. Lack of authority and respect within the
organization which include biased attitude of
management towards staff and lack of
appropriate response on complaints and concerns
reported by staff. A participant shared,
“We are treated at hospital as if we are thieves” (Mrs.
Rukhsana, 2010).
P a g e |6
Some of the participants have experienced discrepancy
between organizational values and educational standards
of AKUSON and other nursing schools often portray AKU
nurses as arrogant, undisciplined and proud nurses.
Resultantly, since we do not accept all their decisions and
we argue against malpractices.
B. Unnecessary
imposition
of
international
standards in nursing care. Participants found that
international standards undermine the values and
judgments of an individual involved in patient
care. Two participants shared,
“We follow international standards but in this
hospital [ AKUH] only…We do not allow our nurses
to do intubation or any procedure without proper
training whereas, in governmental settings and
other private hospitals, nurses are allowed to do
everything through which they gain more
confidence to work independently” (Mrs. Kasam,
2010).
“International standards dominate us to such an
extent that we are often confusing between
following local or internationals norms” (Ms.
Maryam, 2010).
C. Imposition of non-nursing tasks such as clerical
work and documentation increases their work
load and makes nurses feel disempowered.
Nurses find it difficult to take out time to spend
with patients and advocate for their rights. A
nurse brought a point that
“It is mainly about documentation…we keep doing
documentation every time. We do not even get time
to spend without patients talking to them about
their feelings and experience. We can’t really help
our patient even if intend to do” (Ms. Hamidah,
2010).
D. Most commonly, the image of nursing profession
in Pakistan. From one side, the profession of
nursing demands public dealing and, in Pakistan,
women are not allowed to deal with strangers
particularly men by themselves. Therefore they
are considered immoral.
E. At the other side, the profession of nursing follows
medicine in the so-called hierarchal structuring in
the health care system of Pakistan. This way,
doctors are paid and given more respect in
comparison to nurses.
F. Nurse’s own perception of nursing as a lowranked profession. Nurses often consider doctors
as authoritarian to them and do not cherish their
How to Cite this Article: Saleema Gulzar, Dr. Rozina Karmaliani , Nasreen Lalani , Qurratulain Nasiruddin , "Are We Empowered? A Qualitative Approach
to Unfold The Experiences of Female Nurses in Pakistan", Science Journal of Medicine and Clinical Trials, Volume 2015, Article ID sjmct-260, 9 Pages,
2015. Doi:10.7237/sjmct/260
Science Journal of Medicine and Clinical Trials (ISSN:2276-7487)
profession nursing as a noble profession. Some of
the responsible factors, as mentioned by
participants, were lack of knowledge and training
programs for nurses. Thus, unprogressive
professional expertise reduce their ability to think
critical, integrate knowledge in practice and take
extra initiatives in bring innovation in their
practices.
G. Political influence in hospital policies and
management specifically in governmental
settings. At some hospital settings, management is
elected on the basis of their affiliations with
political party. Henceforth, they pose immense
political pressure and individual preferences in
patient care as well and; do not let their staff work
sincerely. The same point is mentioned to be a
major concern for social security of nurses. In
addition, participants shared incidences of
harassment by other co-workers, clerical staff and
sometimes visitors or attendants of patients. At
such instances, participants do not even receive
required support from management.
H. Lack of active participation of PNC in responding
to the requests and complaints of nurses; and
standardized the nursing curriculum all over
Pakistan. This way, the diversity among Pakistani
population and the notion of cultural-sensitivity
in health care has been neglected among nurses.
I.
J.
Gender biasness in the recruitment process where
males are preferred over female nurses as they do
not claim maternity leaves, they are more flexible
with shift-timings and they can do over time and
double duties without much reservation from
family.
Moreover, colleagues and co-workers do not
support a staff member even when there is a
collective complaint made by staff to
management. It was also reported that in health
institutes other than AKUH, there are doctors who
are appointed as nursing managers. Similarly,
participants mentioned that other departments
also do not respect participants. For instance, the
pharmacist does not provide drug if a participants
requests but do provide on the request of a
doctor.
P a g e |7
the mind-set of individuals in that organization. Certain
participants mentioned they often argue and fight for their
rights. They knew the organizational hierarchy for
reporting; so they forwarded their complaint accordingly.
They have seen authorities taking appropriate actions on
their complaints. It is identified from the responses of the
participants that they seek support from colleagues and
family members especially husband in staying firm on
their decisions.
4.6 The Role of AKU-SONAM in Empowering Nurses
While appreciating the teachers at AKU-SONAM, some
participants mentioned that they got empowerment from
their teachers who were confident, supportive,
knowledgeable and committed to their profession and
sincere with responsibilities. Even they found faculty
members rude and strict sometimes when they made a
mistake but they knew that the intention of the faculty
member was to make students firm and hard-working.
Exposure to new learning systems, evidence-based
practices, world health scenarios which are given at AKUH
helped us to remain empowered not just inform of AKU
faculty members and staff but elsewhere as well.
Also, advancement in clinical teaching and learning at
multiple sites, both public and private hospitals, gives
room for faculty members and novice nurses to practice,
enhance learning in areas other than AKU and networking
within different hospitals of the country to bring positive
and innovative changes. With great pride, a participant
shared,
“In the entire health system of Pakistan, it’s just
AKU where the needs of patients are looked
holistically by nurses” (Manager Gulshan, 2010).
A participant mentioned that at AKUH, the physician’s
team and support has also been helpful in elevating her
self-esteem. A participant mentioned that she got
empowered when they first attended the open house of
AKU-SONAM. At that moment, they decided to get into the
profession of nursing seeing the magnificent contribution
of participants.
4.5.1 Impacts of Empowerment in Professional Lives
Another participant regretted that often participants join
AKUH for the sake of earning handsome money or
consider AKU as a gateway to fly abroad. Though a person
earning money in foreign currency appeals other; but the
person do not get equal exposure to learning and skills.
Certain participants believed that participants are
empowered in AKUH because they can advocate for the
rights of their patients. They can argue against doctor in
In experience of a participant, health institutes in Pakistan
other than AKUH still reserve management positions for
male only. This participant works at another health
institute where she has to fight every time to bring a girl
on a management position. However, she was pleased to
share that the organizational culture is changing and even
advocacy of patients whereas it is not observable in
governmental hospitals. Contrastingly, a participant
shared that the salary earned at AKUH helped her to
support her family members financially. This way her
family members involved her in decisions and appreciate
her contributions.
How to Cite this Article: Saleema Gulzar, Dr. Rozina Karmaliani , Nasreen Lalani , Qurratulain Nasiruddin , "Are We Empowered? A Qualitative Approach
to Unfold The Experiences of Female Nurses in Pakistan", Science Journal of Medicine and Clinical Trials, Volume 2015, Article ID sjmct-260, 9 Pages,
2015. Doi:10.7237/sjmct/260
Science Journal of Medicine and Clinical Trials (ISSN:2276-7487)
5.0 Discussion
The life of a female nurse in Pakistan constantly swings
between empowerment and disempowerment.
This
makes it difficult to demarcate empowerment in personal
life from professional life. A nurse may feel empowered at
home but not in her profession and vice versa. On one
hand better pay scale of nurses has brought economic
development in their families. On the other hand, nurses
as women are facing dual burden of responsibilities which
distresses them and impact the quality of life. Nurses
especially being mothers feel mentally and emotionally
disturbed and many a times, the needs of the family
especially children are compromised.
At AKU-SONAM, nurses are encouraged to be assertive and
vocal for their rights. Unfortunately, these characteristics
are not appreciated rather discouraged by socio-cultural
norms. Thus individuals are prepared but the society is
not being prepared. This leads to conflict within
individuals and in the society. Study findings revealed that
nurses from government institutions after receiving
higher studies from AKU face various difficulties when
they go back and serve their own institutions. The level of
acceptance of their roles in their own institutions
decreased and these nurses find it difficult to perform or
bring any major change in the system in their own
institution. These issues can be resolved through effective
networking which is currently the aim of AKU-SONAM and
programs like mentorship and preceptor ship can provide
better solutions to such issues. Such needs require more
attention by national councils for nurses.
In governmental settings as well, the career structure and
grades for nurses has progressed. Multiple roles have been
introduced from basic to advance level care. Presently,
nurses are working as clinical nurse specialist, case
managers, information technology nurse, occupational
nurse, rehabilitation nurse, community health nurse,
school health nurse, and nurse researchers. Nonetheless,
in comparison to AKU, nurses are not seen as equal
contributor in health promotion. At AKU, nurses are
considered as significant part of a health care team. This
sense of supremacy among nurses also arrived by
observing other nurses in leading roles such as the Dean of
school of nursing, the Director of Nursing Services.
However, in settings other than AKU, leadership is still
reserved for, doctors and physicians.
The socio-cultural norms and political set up are integral
in determining women’s empowerment. The upbringing of
women, her position in the family, family values, support
systems available, and the socio-political environment all
determine women’s empowerment both in their personal
and professional lives. One’s belief system also remains
integral in strengthening personal satisfaction and
strengths. Studies have proved that religious and spiritual
form of cognitive frameworks alleviate distress, decrease
depressive symptoms, enhance self-esteem and bring
satisfaction in life (Good and Willoughby, 2008;
Pargament et.al 2001).
P a g e |8
Faith, as described by Kim (2001), is the belief in the
power to overcome evil and sin. It was observed that most
of the participants agreed upon the role of faith in
achievement and success. According to Pargament (1997),
faith functions as a ‘positive religious’ coping mechanism.
By virtue of faith, a person perhaps relax and concentrates
more upon possibilities and solutions of a problem instead
of wondering ‘what is the problem?’ or ‘why something
happened to him?’ When people have a faith, as on God or
a deity, this becomes easier for the person to relate
personal experiences and drive meaning of events out of
divine guidance. For them, every occurrence is according
to the will and wish of the God to whom that person is
submissive. This is a reason that people who believe in
God are resilient and promote to healing and well-being
quicker than those people who do not keep any faith
(Dyke et.al, 2009). Thus, faith that God will give them
power to overcome obstacles keep reinforcing female
nurses optimistically leading towards more success and
strength.
Other sources of empowerment include education, ongoing training programs and institutional support.
Unfortunately, these sources of empowerment are not
efficient sources of empowerment for female nurses in
Pakistan. Firstly, women accounts for 12 percent of 26
percent literacy rate in Pakistan (UNESCO, 2012). Since
education has a positive relationship with empowerment
(Rahman et.al. 2011), undesirably, there is a large number
of Pakistani women facing disempowerment in varying
manner though. Secondly, Buzdar et.al. (2011)
recommends that legal rights of women and ordinances
should form an educational component in higher
education but it is found missing in federal and provincial
curriculum of Pakistan. Thus, those fortunate women who
manage to receive education remain unaware of their
rights and laws. In specific to nursing, it falls under the
responsibility of educational institutions and curriculum
planner to educate nurses about their rights as women so
they do not become victim of harassment at home or work
places. Thirdly, since prestige of women in Pakistani
traditional societies is considered to be a direct
determinant of family honor (Noreen and Khalid, 2012),
nurses are not allowed by male family members to
continue their job. Such male dominancy at home along
with experiences of harassment at work further
deteriorates courage and motivation of a woman. For such
reasons, it is highly significant that nursing institutes and
hospitals ensure provision of legal rights to nurses to work
in a safe environment whether in presence or absence of
male colleagues.
In such circumstances, the role of nursing institute is
significant. The support received by nursing institutes
function in at least two major ways. Firstly, the institute
empowers nurses to function well in professional
environment. Resultantly, there are more courageous, firm
and confident nurses in health care settings which
supposedly improves health scenario in Pakistan.
How to Cite this Article: Saleema Gulzar, Dr. Rozina Karmaliani , Nasreen Lalani , Qurratulain Nasiruddin , "Are We Empowered? A Qualitative Approach
to Unfold The Experiences of Female Nurses in Pakistan", Science Journal of Medicine and Clinical Trials, Volume 2015, Article ID sjmct-260, 9 Pages,
2015. Doi:10.7237/sjmct/260
Science Journal of Medicine and Clinical Trials (ISSN:2276-7487)
P a g e |9
Secondly, the satisfaction and confidence in work enable
nurses to strengthen social ties and family relations.
8.
Good, M., & Willoughby, T. (2008). Adolescence as a sensitive period
for spiritual development. Child Development Perspectives, 2, 32–
37.
The contribution of AKUSONAM in empowering female
nurses is evident. Their faculty members and staff are role
models to their students. The curriculum and teaching
methodologies are ways of empowering the nurses. The
nurses at AKU find themselves more autonomous and
empowered which in turn results in increased job and
patient satisfaction. However, all nurses verbalized that
various degree of medical dominancy exist overall in the
profession both at AKU and other institutions.
9.
Hemani, J. (1996). History of Nursing in Pakistan. Peshawar:
Peshawar National Book.
Conclusion
Pakistani nurses are facing double challenge in leading
their personal and professional life as independent and
empowered individuals. The socio-cultural and political
setup in Pakistani society does not always favor nurses to
function up to the best of their capabilities. In such
scenarios, the role of nursing school is significant. Through
nursing schools and regulatory bodies, the image of nurses
and the status of women can be uplifted.
The AKU-SONAM is a leading example in this dimension.
The institute has played a pivotal role in enhancing the
legitimacy of nurses as Muslim women at least in the
context of Pakistani society. The graduates and trained
nurses of AKU-SONAM are making impact not just in their
profession but in personal life as well. However, there is
serious attention required by federal and national
regulatory bodies of nurses to work in order to uplift the
status of nurses in Pakistan nationally.
10. Illiyas and Ansari (2000).Community Medicine and Public Health
(5th Ed.) Karachi: TimeTraders.
11. Kim, H. K. (2001). Faith Seeking Empowerment: Youngsan’s
Pentecostal Doctrine of Providence. Journal of Youngsan
Theology, 22, 209-234.
12. Noreen, G. and Khalid, H. (2012). Gender Empowerment through
Women’s Higher Education: Opportunities and Possibilities. Journal
of Research and Reflections in Education,Vol.6, No.1, pp 63 -76.
13. Pargament, K. I., Koenig, H. G., Tarakeswar, N., & Hahn, J. (2001).
Religious struggle as a predictor of mortality among medically ill
elderly patients: A two-year longitudinal study. Archives of Internal
Medicine, 161, pp1881–1885.
14. Rahman, M., Hoque, A. and Makinoda, S. (2011). Intimate Partner
Violence Against Women: Is Women Empowerment a Reducing
Factor? A Study from a National Bangladeshi Sample. Journal of
Family Violence, 26, pp. 411–420.
15. Sheer, D. (1996). Reaching collaboration through empowerment: A
developmental process. The Journal of Obstetric, Gynecologic, and
Neonatal Nursing, 25, 513-517.
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relationship of religious coping and spirituality to adjustment and
psychological distress in urban early adolescents. Mental Health,
Religion & Culture, 12, 369–383.
17. Yusufzai, A. (2006). Nurses Get Little Training or Respect. Retrieved
on June 15th, 2006 from www.ipsnews.net/news.
18. Rowling, J.K. Harry Potter and the Chamber of Secrets. New York:
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How to Cite this Article: Saleema Gulzar, Dr. Rozina Karmaliani , Nasreen Lalani , Qurratulain Nasiruddin , "Are We Empowered? A Qualitative Approach
to Unfold The Experiences of Female Nurses in Pakistan", Science Journal of Medicine and Clinical Trials, Volume 2015, Article ID sjmct-260, 9 Pages,
2015. Doi:10.7237/sjmct/260